Preventive treatment can delay or prevent the development of Rheumatoid Arthritis

Starting preventive treatment at an early stage can delay or even prevent the development of rheumatoid arthritis (RA) in individuals with a high risk profile for the disease. This is the conclusion of researchers from institutions including the LUMC, Erasmus MC, Haga Hospital, and Haaglanden MC, based on a long-term study recently published in The Lancet Rheumatology.

Several Medical Delta researchers were involved in the study, which was conducted in collaboration with various hospitals in South Holland.

Rheumatoid arthritis is one of the most common autoimmune diseases and causes chronic inflammation in the joints. People with RA experience pain; the disease burden and societal costs due to disability are high.

Preventive treatment in high-risk groups proves effective

The researchers monitored a group of 236 individuals over four years who were assessed as having a low to high risk of developing RA. People with so-called 'subclinical inflammation'—where inflammation is visible in at least one joint on an MRI—were identified as 'high-risk patients.' Additionally, a distinction was made between individuals with autoantibodies (ACPA) and those without autoantibodies in their blood, as these two groups have different underlying mechanisms for the development of RA.

Part of the research group was prescribed a treatment, while another part received a placebo.

Notably, in the high-risk group of people without autoantibodies, significantly more individuals developed RA when given a placebo compared to a similar group that received early medication. This is an important indicator that early treatment can have a preventive effect in this group. Among individuals in the high-risk group with autoantibodies, early initiation of medication appears to delay the development of RA.

Early Diagnosis is Key

Early diagnosis can ensure that individuals who are on the path to developing rheumatoid arthritis enter treatment earlier, thereby experiencing less discomfort. In people who do not have autoantibodies but are at high risk for developing RA, many joint inflammations are visible on an MRI scan. This means that an MRI is necessary to catch these individuals at an early stage.

"The results are an important motivation to conduct further research into early diagnosis," says Prof. Dr. Annette van der Helm (LUMC, Erasmus MC). This is being done, among other things, in the recently launched Medical Delta Program ‘From man to machine – early identification of rheumatoid arthritis’. Through this program, we are looking for a way to use technology to make the RA diagnosis process more efficient and faster, with less involvement from doctors and at lower costs."

With a short MRI scan, it is possible to identify specific joint inflammations; using machine learning and AI algorithms, the program aims to make diagnoses faster. "The ultimate goal is to screen more people earlier, allowing us to start preventive treatment sooner in individuals at high risk of developing RA."

Meer informatie

Read here the study ‘Development of rheumatoid arthritis after methotrexate in anticitrullinated protein antibody-negative people with clinically suspect arthralgia at risk of rheumatoid arthritis: 4-year data from the TREAT EARLIER trial’

See here the Medical Delta program ‘From man to machine – early identification of rheumatoid arthritis’

Watch the inaugural lecture video of Medical Delta professor, Prof. Dr. Annette van der Helm, below: